Perceptions of the public healthcare system from private-care patients with irritable bowel syndrome with constipation in Spain

Background: Irritable bowel syndrome (IBS) is associated with reduced health-related quality of life. Patients with IBS benefit from positive patient-provider experiences during treatment. However, many continue to suffer from limited symptom relief and hold negative perceptions. Purpose: to identify potential barriers perceived by patients with IBS with constipation (IBS-C) within the the private health care system compared with the care under the public health-care system in Spain. Methods: this is a multicenter, cross-sectional observational study. Patients with previous experience of public healthcare who attended a private consultation with a gastroenterologist due to constipation/abdominal discomfort, with no previous IBS diagnosis and meeting Rome III criteria at the time of survey completion without alarm symptoms, were invited to join the study. Participants completed the Irritable Bowel Syndrome Patient Experience questionnaire, the Irritable Bowel Syndrome Symptom Severity Score questionnaire and the EuroQol five-dimensions questionnaire, reporting their health-related quality of life. Results: seven hundred and seven patients met the study criteria and were evaluated. With regard to public healthcare, patients reported feeling more positive towards their gastroenterologist (62.8% satisfied) than their primary care physician (43.9% satisfied). Patients reported moderate/severe problems with pain/discomfort (61.5%). The majority of patients were treated with fiber (85.3%), laxatives (79.3%) and antispasmodics (54.3%); 47.0% and 11.7% of patients noted little and no improvement, respectively. Conclusions: the perceptions of patients with irritable bowel syndrome and constipation were more positive towards their gastroenterologist than their primary care physician in the public healthcare sector. However, patients were still dissatisfied with the treatment and care received, highlighting the unmet need for improved patient-provider communication to achieve better outcomes

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Estudio de incidencia de eventos adversos en una clínica privada en Chile / Incidence of adverse events in a private hospital in Chile

Objetivos. Determinar la incidencia y tipos de eventos adversos (EA) en pacientes hospitalizados en la Clínica Vespucio, describir sus causas inmediatas, definir los EA evitables y determinar los servicios con mayor tasa. Material y método. Estudio retrospectivo de cohortes en pacientes dados de alta entre el 16 y el 31 de enero de 2012. Para la identificación de EA se revisan las fichas clínicas y se les aplica la guía de cribado de efectos adversos adaptada del estudio de Harvard. A los pacientes con cribado positivo se les aplicó la versión española del Formulario modular para revisión retrospectiva de casos (Modular Review Form; MRF2) del Estudio Eneas de 2005. Resultados. Se incluyeron en el estudio 500 pacientes, de los que 31 presentaron EA relacionados con la asistencia sanitaria (6,2%), con una densidad cada 100 días/cama de 3,46 (leves 2,72, moderados 0,65 y graves 0,09). Los procesos asociados fueron: cuidados 32,4%, procedimientos 32,4%, medicación 13,5%, infecciones nosocomiales 10,8% y diagnóstico 8,1%. Se consideró evitable el 67,6%. Un 40,5% requirió procedimientos adicionales y un 35,1% tratamientos adicionales. En un 5,4% se prolongó la estancia media 5,5 días y un 8,1% causó reingreso. El 91,9% no generó incapacidad. Los servicios con mayor tasa por cada 100 altas fueron: unidad de pacientes críticos (21,4), obstetricia y ginecología (7) y médico quirúrgico (6). Conclusiones. Este es el primer estudio realizado en un hospital privado en nuestro país y que nos permitió identificar la incidencia y tasa global y por servicios de EA, su gravedad, evitabilidad y sus factores causales (AU)

Objectives. To determine the incidence and type of adverse events (AE) in hospitalized patients in Vespucio Clinic, to describe their immediate causes, define avoidable AE and determine the services with highest AE rate Material and method. Retrospective cohort study, in patients discharged between 16 and 31 January 2012. For the identification of AE, medical history was reviewed, and the AE screening guide adapted from the Harvard study was applied. The Spanish version of Modular Review Form MRF2 used in the ENEAS 2005 Study was applied to the patients with positive screening. Results. From the 500 patients studied, 31 had some AE related to health care (6.2%), with an incidence of 3.46 for every 100 patient bed days (minor events 2.72, moderate 0.65, and severe 0.09). The associated processes were: Care 32.4%, medication 13.5%, infections associated with health care10.8%, and diagnostics 8.1%. More than two-thirds (67.6%) were considered avoidable. Of the adverse events, 40.5% required additional procedures, and 35.1% additional treatment. Hospital stay was extended by an average of 5.5 days in 5.4%, and 8.11% led to re-admission. Most of them (91.9% did not cause any incapacity. The departments with the highest AE rates per 100 bed patients days were: Critical Care Unit (21.4), obstetrics and gynecology (7), and medical/surgical wards (6) Conclusions. This is the first study conducted in a private hospital in our country that allowed us to identify the incidence, overall rate, and the rate by departments of adverse events, their severity, preventability and causal factors (AU)

[Development of Human Health Discoveries. 10 years results of Young Innovative Company incubation]. / Le développement des découvertes en Santé Humaine. Résultats de 10 ans d'incubation de Jeunes Entreprises Innovantes.

Medicine is evolving every day in its operating procedures and the services offered to patients, emphasizing personalized medicine, safety and medical benefits. The individual patient is more than ever the hub of healthcare organization. Medical innovation is thus a public health priority. However it requires an accurate assessment of medical utility and risk-benefit ratios, and in-depth analysis of economic and organizational impacts. Ten years of experience in the Paris Biotech Santé company incubator has identified key actions for effective support of research projects and the success of innovative companies. Strong expertise is needed to prepare development plans, ensure compliance with regulatory requirements and obtain research funding. During its first decade, this incubator has created 87 innovative companies employing 1500 people, raised more than 90 million euros of funding, and reached a cumulative company value of 1200 million euros. Key factors of success have been identified, but an analysis of the causes of failure shows that operational adjustments are mandatory, particularly a strong commitment from medical experts, in order to promote access to new and useful products for patients while at the same time assessing their social impact.

Stroke initial severity and outcome relative to insurance status in a universal health care system in Switzerland.

BACKGROUND: Socioeconomic status is thought to have a significant influence on stroke incidence, risk factors and outcome. Its influence on acute stroke severity, stroke mechanisms, and acute recanalisation treatment is less known. METHODS: Over a 4-year period, all ischaemic stroke patients admitted within 24h were entered prospectively in a stroke registry. Data included insurance status, demographics, risk factors, time to hospital arrival, initial stroke severity (NIHSS), etiology, use of acute treatments, short-term outcome (modified Rankin Scale, mRS). Private insured patients (PI) were compared with basic insured patients (BI). RESULTS: Of 1062 consecutive acute ischaemic stroke patients, 203 had PI and 859 had BI. They were 585 men and 477 women. Both populations were similar in age, cardiovascular risk factors and preventive medications. The onset to admission time, thrombolysis rate, and stroke etiology according to TOAST classification were not different between PI and BI. Mean NIHSS at admission was significantly higher for BI. Good outcome (mRS≤2) at 7days and 3months was more frequent in PI than in BI. CONCLUSION: We found better outcome and lesser stroke severity on admission in patients with higher socioeconomic status in an acute stroke population. The reason for milder strokes in patients with better socioeconomic status in a universal health care system needs to be explained.

The emergence of proprietary medical facilities in China.

This paper analyzes the evolution and development of market conditions and government policies that have favored the emergence of proprietary medical facilities in China. Excess and differentiated demand for medical services, the existent profitability and supply of the investment capital in health care market, and favorable government policies have encouraged the entrance of proprietary facilities in health care market. The paper further analyzes why nonprofit health organizations are not an optimal organizational form in the current Chinese health care market. After discussing the strengths and weaknesses of proprietary ownership in health care market in China, the paper concludes with important managerial and policy suggestions.

For-profit conversion and merger trends among Blue Cross Blue Shield health plans.

Blue Cross and Blue Shield (BCBS) health plans, which insure nearly one in three Americans, historically have operated as local, nonprofit or mutual organizations. However, since the mid-1990s, BCBS plans increasingly have converted to for-profit companies and merged with Blue plans in other states. State insurance regulators, charged with weighing the costs and benefits of conversions and mergers to consumers, often wrestle with the legal complexities of these deals, according to Center for Studying Health System Change (HSC) site visits to 12 nationally representative communities. Although state regulatory scrutiny has slowed the pace of conversions recently, conversion activity is likely to accelerate again as the political and regulatory landscapes shift and plans adapt conversion strategies. The limited evidence available from HSC site visits and conversion proceedings suggests that conversions and mergers have had neither significant negative nor positive effects on consumers.

Models for future delivery of care in infertility: the role of the private sector.

An estimated 85% of infertility treatment at the tertiary level in the UK currently is funded by the infertile couples themselves. Of the 15% of couples who receive NHS funding for assisted reproductive technology (ART), a sizeable proportion is provided by private clinics. If the National Institute of Clinical Excellence (NICE) decides that the National Health Service (NHS) should provide funding for an increased number of treatments, then it is unlikely that wholly NHS ART clinics will be able to provide the extra number of cycles required. Those private clinics in the UK that bid to provide treatment funded by the NHS through primary care trusts (PCT) generally provide a cost-effective service in a 'patient friendly' environment. The case is made in this article that ART clinics in the private sector that wish to bid for PCT contracts, should be allowed to compete on an equal basis with NHS or NHS-private combined clinics. PCTs awarding contracts should be wholly driven by good evidence of clinical effectiveness, cost effectiveness and the provision of a quality service to patients.